And the prize behind Door #2 is ...

When I first saw this MSNBC.com story about medical practices with two doors, I thought it was a metaphor. But, no, apparently some practices literally have two doors leading to different waiting rooms: one for insured patients and another snazzier one for cash-paying "boutique" patients.

The MSNBC.com investigation revealed that, as you might expect, the speed, the service and the little touches (spa robe or paper gown?) were crummier on the insurance side. The findings prompted an outraged op-ed from ethicist Arthur Caplan, but I'm a little more undecided about the system.

Sure, I'd rather get an appointment right away and wear a fancy robe, but am I willing to spend my hard-earned money on these perks? Nope. Caplan compares boutique medicine to airlines charging for checked bags, but I think the more accurate parallel in this situation is the choice between economy and first class. If some people want to pay for extra frills, does that have any negative impact on those who don't? In the case of both the flight and the two-doored radiology practice, their payments are helping to support the same infrastructure that everyone else is using.

Obviously, if the cash patients are receiving such a different level of care that they have different clinical outcomes, or the trend catches on so widely that you can't get good quality care without paying a surcharge, that's a different story. Two doors may be more ethically questionable than one, but they sure beat none.

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